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19 years
Why when someone hits his head or has an accident the doc says, " do not sleep!" ? Why is sleeping bad in such state and in general what are the cases in which you are forbbiden to sleep? Thank you.
Aug 11, 2014

Dr. Rania Mousa General Medicine
Following the injury, if the person is awake (conscious), and there is no deep cut or severe head damage, it is unusual for there to be any damage to the brain.

However, sometimes a knock to the head can cause damage to the brain or to a blood vessel next to the brain. A damaged blood vessel may bleed into the brain, or more commonly, into the area between the brain and the skull (a subdural haemorrhage). This is uncommon, but can be serious, as a build-up of clotting blood can cause pressure on the brain.

Symptoms of damage or bleeding may not develop for some hours, or even days, after a knock to the head. In rare cases, symptoms from a slow bleed can develop even weeks after a head injury.

The patient is advise to be awake becuase he must be watched for the following and if he sleeps the process or assessment will be inaccurate or harder ,however if the patient or a child got asleep th edoctor may wake him every 2 hours to see if there is a chenge in the necessary watched signs to see for wel being and consequence treatment .

>The SIGNS TO BE WATCHED and consider being awake are :
Drowsiness , loss of consciousness or penetrating injury to the head,Worsening headache - which does not go away with paracetamol or ibuprfen,Confusion, strange behavior, and any problems with understanding or speaking,Inability to remember events before or after the head injury,vomiting,weakness in an arm or a leg,loss of balance or walking strangely,Any visual problems, such as blurring of vision or double vision,Blood or clear fluid leaking from the nose or ear,New deafness in one or both ears,Unusual breathing patterns.

If none of the above are present, your doctor may still send you to be assessed in accident and emergency. Your doctor will do this if there are any concerns regarding the diagnosis, there is altered behaviour or irritability (particularly in children) or there is no one to be with you for the first 24 hours of the head injury.

The only real acute problem after hitting the head to watch for -and consequently patient should be woken up during the 1st night a few times, is a suspicion of an epidural hematoma. It is a bleed inside the skull. It usually requires high energy trauma like hit by a car and falling on asphalt or some such.

Epidural hematoma can come in a few hours, is arterial>>>it won't stop until the pressure is above arterial pressure>>>>it is usually lethal unless operated. BUT: it requires arterial damage, which often means skull fracture.

SO getting one after hitting the head on a board would be extremely unlikely. But, if you feel insecure, the patient is wake up every 3-4 hours during the 1st night-not needful afer that - and see that there is no increasing headache, confusion, problems in seeing, asymmetry in pupil size (new onset).

Subdural heamtomas are venous bleeds and come slower -so the symptoms like increasing headache, increasing confusion, motor deficits etc. will come in some days -weeks.So there is plenty of time to notice these. These are also very rare after low energy trauma in younger people -chronic subdural hematomas are more common in older people.

Concussion is a very vague term meaning some degree of damage to nerve tracts in brain.Degrees of damage vary a lot, often not easily estimated from the forces that hit the head.

Most often there is not much that can be done to these -the symptoms will get better by time.
If the patient was not unconscious at all and remembers everything both from before and after the trauma, I would not be very worried. The time of unconsciousness and the length of time not remembered before or after the trauma are used to gauge the severity of the incident.

The big bump outside skull can be unpleasant and hurt but most likely nothing serious has happened inside the skull. tiredness will go away after a few days.If not, or if increasing symptoms, see a doctor.